Racial and Economic Neighborhood Segregation, Site of Delivery, and Morbidity and Mortality in Neonates Born Very Preterm

J Pediatr. 2021 Aug;235:116-123. doi: 10.1016/j.jpeds.2021.03.049. Epub 2021 Mar 29.


Objective: To assess the influence of racial and economic residential segregation of home or hospital neighborhood on very preterm birth morbidity and mortality in neonates born very preterm.

Study design: We constructed a retrospective cohort of n = 6461 infants born <32 weeks using 2010-2014 New York City vital statistics-hospital data. We calculated racial and economic Index of Concentration at the Extremes for home and hospital neighborhoods. Neonatal mortality and morbidity was defined as death and/or severe neonatal morbidity. We estimated relative risks for Index of Concentration at the Extremes measures and neonatal mortality and morbidity using log binomial regression and the risk-adjusted contribution of delivery hospital using Fairlie decomposition.

Results: Infants whose mothers live in neighborhoods with the greatest relative concentration of Black residents had a 1.6 times greater risk of neonatal mortality and morbidity than those with the greatest relative concentration of White residents (95% CI 1.2-2.1). Delivery hospital explained more than one-half of neighborhood differences. Infants with both home and hospital in high-concentration Black neighborhoods had a 38% adjusted risk of neonatal mortality and morbidity compared with 25% of those with both home and hospital high-concentration White neighborhoods (P = .045).

Conclusions: Structural racism influences very preterm birth neonatal mortality and morbidity through both the home and hospital neighborhood. Quality improvement interventions should incorporate a framework that includes neighborhood context.

Keywords: NICU; hospital quality; preterm birth; structural racism.

MeSH terms

  • Adult
  • Black or African American / statistics & numerical data*
  • Cohort Studies
  • Female
  • Hospitals / statistics & numerical data
  • Humans
  • Infant
  • Infant Mortality*
  • Infant, Newborn
  • Infant, Newborn, Diseases / epidemiology
  • Infant, Premature*
  • New York City / epidemiology
  • Pregnancy
  • Premature Birth / epidemiology*
  • Residence Characteristics*
  • Retrospective Studies